Effect of Dominant Hand Paralysis on Quality of Life in Patients With Subacute Stroke

OBJECTIVE: To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. METHODS: We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI). RESULTS: We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. CONCLUSION: The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.

Frankfort horizontal plane is an appropriate three-dimensinal reference in the evaluation of clinical and skeletal cant

OBJECTIVES: In three-dimensional computed tomography (3D-CT), the cant is evaluated by measuring the distance between the reference plane (or line) and the tooth. The purpose of this study was to determine the horizontal skeletal reference plane that showed the greatest correlation with clinical evaluation. MATERIALS AND METHODS: The subjects were 15 patients who closed their eyes during the CT image taking process. The menton points of all patients deviated by more than 3 mm. In the first evaluation, clinical cant was measured. The distance from the inner canthus to the ipsilateral canine tip and the distance from the eyelid to the ipsilateral first molar were obtained. The distance between the left and right sides was also measured. In the second evaluation, skeletal cant was measured. Six reference planes and one line were used for the evaluation of occlusal cant: 1) FH plane R: Or.R - Or.L - Po.R; 2) FH plane L: Or.R - Or.L - Po.L; 3) F. Ovale plane R: Rt.F.Ovale - Lt.F.Ovale - Or.R; 4) F. Ovale plane L: Rt.F.Ovale - Lt.F.Ovale - Or.L; 5) FZS plane R: Rt.FZS - Lt.FZS - Po.R; 6) FZS plane R: Rt.FZS - Lt.FZS - Po.L, and; 7) FZS line: Rt.FZS - Lt.FZS. RESULTS: The clinical and skeletal cants were compared using linear regression analysis. The FH plane R, FH plane L, and FZS line showed the highest correlation (P<0.05). CONCLUSION: The FH plane R and FH plane L are the most appropriate horizontal reference plane in evaluation of occlusal cant on 3D-CT.

Occurrence of multiple myeloma in the head and neck: a report of two cases

Multiple myeloma (MM) is a disease reported to account for 1% of all cancers and 10% of hematological malignant diseases. Unlike other malignant diseases that are transferred to the osseous tissues, MM does not show new bone formation, is associated with characteristic osteolytic lesions, and shows monoclonal protein (M-protein) on the immunohematological test, which is an important index in its diagnosis. Solitary lesions of MM are rare in the head and neck area, and, in most cases, MM of the head and neck area is related to systemic sympomts.

Feasibility and Effects of Newly Developed Balance Control Trainer for Mobility and Balance in Chronic Stroke Patients: A Randomized Controlled Trial

OBJECTIVE: To investigate the feasibility and effects of balance training with a newly developed Balance Control Trainer (BCT) that applied the concept of vertical movement for the improvements of mobility and balance in chronic stroke patients. METHOD: Forty chronic stroke patients were randomly assigned to an experimental or a control group. The experimental group (n=20) underwent training with a BCT for 20 minutes a day, 5 days a week for 4 weeks, in addition to concurrent conventional physical therapy. The control group (n=20) underwent only conventional therapy for 4 weeks. All participants were assessed by: the Functional Ambulation Categories (FAC), 10-meter Walking Test (10mWT), Timed Up and Go test (TUG), Berg Balance Scale (BBS), Korean Modified Barthel Index (MBI), and Manual Muscle Test (MMT) before training, and at 2 and 4 weeks of training. RESULTS: There were statistically significant improvements in all parameters except knee extensor power at 2 weeks of treatment, and in all parameters except MBI which showed further statistically significant progress in the experimental group over the next two weeks (p<0.05). Statistically significant improvements on all measurements were observed in the experimental group after 4 weeks total. Comparing the two groups at 2 and 4 weeks of training respectively, 10mWT, TUG, and BBS showed statistically more significant improvements in the experimental group (p<0.05). CONCLUSION: Balance training with a newly developed BCT is feasible and may be an effective tool to improve balance and gait in ambulatory chronic stroke patients. Furthermore, it may provide additional benefits when used in conjunction with conventional therapies.

Osteonecrosis of the Jaw in a Patient with Osteoporosis Treated with Oral Bisphosphonates / 대한정형외과학회잡지

Bisphosphonates are widely used in the management of metastatic bone disease and in the prevention of osteomalacia and osteoporosis. In particular, oral preparations are more commonly used for the prevension and treatment of osteoporosis. Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been well documented recently in relation to intravenous preparations of the drug. But, a few cases have been reported of oral bisphosphonate-associated osteonecrosis. We could not find any risedronate cases in the Korean medical literature. Here we report a case of BRONJ in a 91-year-old woman patient receiving an oral bisphosphonate (risedronate) for the treatment of osteoporosis.

Living Sparganosis in the Forearm Flexor Muscle / 대한정형외과학회잡지

Sparganosis is caused by tapeworm larva of the genus Spirometra, which commonly invades the subcutaneous tissue, and less frequently invades the abdominal wall, intestine, muscle, thorax, breast, eye, brain, spinal cord etc. We experienced a rare case of living sparganosis, which was found in the flexor muscle of the distal forearm. Ultrasonography was helpful in the diagnosis of sparganosis

A Case of Mollaret Meningitis

Mollaret meningitis is a recurrent aseptic meningitis with characteristic clinical features and Mollaret cells in cerebrospinal fluid. Since Mollaret first reported Mollaret meningitis in 1944, further reports had been made mainly in Europe. The syndrome consists of brief attacks of meningitis that recur at regular intervals and alternate with a symptom-free period lasting for weeks or months. The symptoms subside as quickly as they develop, and the patient is completely asymptomatic until the next episode, without any residual neurologic abnormalities. Specific changes in the cytologic pattern of the cerebrospinal fluid occur over the course of an attack. In the early stages, polymorphonuclear leukocytes and endothelial cells appear in the cerebrospinal fluid, called Mollaret cell. We experienced a case of Mollaret meningitis in a 15-year-old female child who had 5 episodes of recurrent aseptic meningitis, always accompanied by vesicles on the face and anterior neck. We observed Mollaret cells which had faint, finely vacuolated cytoplasm, eccentrically located nuclei show on Papanicolau stain. We present a case of Mollaret meningitis with a brief review of related literatures.

A Case of Mollaret Meningitis

Mollaret meningitis is a recurrent aseptic meningitis with characteristic clinical features and Mollaret cells in cerebrospinal fluid. Since Mollaret first reported Mollaret meningitis in 1944, further reports had been made mainly in Europe. The syndrome consists of brief attacks of meningitis that recur at regular intervals and alternate with a symptom-free period lasting for weeks or months. The symptoms subside as quickly as they develop, and the patient is completely asymptomatic until the next episode, without any residual neurologic abnormalities. Specific changes in the cytologic pattern of the cerebrospinal fluid occur over the course of an attack. In the early stages, polymorphonuclear leukocytes and endothelial cells appear in the cerebrospinal fluid, called Mollaret cell. We experienced a case of Mollaret meningitis in a 15-year-old female child who had 5 episodes of recurrent aseptic meningitis, always accompanied by vesicles on the face and anterior neck. We observed Mollaret cells which had faint, finely vacuolated cytoplasm, eccentrically located nuclei show on Papanicolau stain. We present a case of Mollaret meningitis with a brief review of related literatures.

Clinical Evaluation of Stroke in Infants and Children

PURPOSE: The causes of stroke in children are varied and morbidity by stroke is significant, it needs further investigations to identify the underlying causes. Despite significant morbidity in childhood, only a few studies have been reported. So we reviewed retrospectively clinical records, diagnosed stroke in neuroradiologic study and analyzed sex, age, cause, clinical features, mortality, lesion of brain injury and residual deficits. METHODS: From January 1994 to July 1997, 67 patients diagnosed with stroke in neuroradiologic study were studied retrospectively. We described age, sex distribution, underlying causes, clinical features, mortality, lesion of brain injury and residual deficits. RESULTS: There were 50 cases(74.6%) of ischemic stroke and 14 cases(20.9%) of hemorrhagic stroke. The most common cause was moyamoya disease in ischemic stroke and hemato- oncologic disease in hemorrhagic stroke. The presenting features were seizure, 30 cases(44.8%) ; motor deficit, 27 cases(40.3%) ; mental change, 15 cases(22.4%) ; and headache, 11 cases(16.4%). Forty-five cases(67.1%) involved carotid system and 13 cases(19.5%) involved vertebrobasilar system. The mortality rate was 19.4% and the rate of residual deficit was 63.0%. CONCLUSION: Cerebrovascular disease in childhood is not an uncommon occurrence in Korea considering these results. As a consequence of medical progress, early mortality rate has decreased, but the rate of residual deficits tended to increase. So further studies on childhood stroke are required for early diagnosis and treatment which are important in decreasing mortality and morbidity.

A Case of Gastric Submucosal Tumors in Children Diagnosed by Endoscopic Ultrasonography / 대한소화기내시경학회지

Benign neoplasms of the stomach are uncommon in children. They include adenomatous and hyperplastic polpys, leiomyomas, lipomas, and other lesions. Gastric leiomyoma in childhood represent only 1% of all gastrointestinal neoplasms reported, and slightly more than half of these are gastric. The tumor arises in the muscle layer of the stomach and is usually intragastric and submucosal. Barium contrast studies are useful in localizing leiomyoma with significant intramural or submucosal growth. An endoscopy can permit histologic confirmation if the tumor has eroded through the mucosa. Differentiation however, of malignant lesions from benign submucosal leiomyomas may be difficult. Using endoscopic ultrasonund imaging, highly accurate gastrointestinal tumor characterization, especially submucosal masses, and differentiation of malignant from benign lesion are now relatively possible without surgery. We experienced a case of a gastric submucosal tumor regarded as a leiomyoma, which was diagnosed using endoscopic ultrasonography, and report the findings with a review of related literatures.